IN THIS ISSUE

Adolescents who engage in “high-risk” patterns of sexual behavior do
not necessarily develop into young adults with poor sexual and reproductive
health, Abigail A. Haydon and colleagues report in this issue
of Perspectives on Sexual and Reproductive Health (page 218). In analyses
using three waves of data from the National Longitudinal Study
of Adolescent Health, the researchers compared outcomes among
five groups of young adults, defined by the sequence, spacing, timing
and variety of their sexual experiences during adolescence. The
most prevalent pattern of behavior was initiation of vaginal sex and
then, within about two years, another sexual behavior (typically oral
sex). Compared with young adults reporting this pattern, those who
had begun having oral and vaginal sex in the same year were no more
likely to have had an STD (ever or in the past year) or to have recently
had concurrent partners or exchanged sex for money; those who had
experienced both early first sex and anal sex by age 18 had elevated
odds only of reporting concurrent partnerships. The small minority of
respondents who had delayed their first sexual experience until late
adolescence or beyond had reduced odds of all adverse outcomes.

Haydon and colleagues comment that teenage sexual behavior “is
certainly not without risk.” However, they argue that federal policies
aimed at promoting abstinence until marriage “reflect strong assumptions
about optimal pathways to sexual development that have not
been subjected to rigorous empirical tests and…are inconsistent with
the vast majority of young people’s experiences.” The task for health
care providers and researchers, the authors conclude, is to understand
“the diversity of pathways that contribute to healthy sexual
development.”

Also in This Issue

•In a study of low-income Latina pill users in El Paso, Texas, a substantial
proportion of women wanted no more children, and most of
these wished to undergo sterilization. However, as Joseph E. Potter
and colleagues report (page 228), few had had the operation by the
time of an 18-month follow-up interview, and most of those who had
not been sterilized still wanted to be. In qualitative interviews, the
investigators learned that barriers to sterilization included procedures
pertaining to Medicaid coverage and providers’ “ad hoc criteria” for
performing the operation. The findings, according to the authors, offer
“insight into structural factors underlying contraceptive inequity” and
demonstrate that women’s current contraceptive method is not necessarily
their preferred one.

•Close to half of sexually active U.S. 18–29-year-olds are unsure about
their pregnancy desires, but men are more likely than women to be
ambivalent, Jenny A. Higgins and coauthors find in analyses of nationally
representative data from a 2008–2009 survey (page 236).
Moreover, among men (but not women), those who are ambivalent
are less likely to say that they and their partner use contraceptives than
are those who have a clear desire to avoid pregnancy. The investigators
“strongly encourage public health practitioners to explore whether
helping men as well as women clarify their pregnancy desires…could
help improve contraceptive use and reduce unintended pregnancies.”

•Adolescents’ pregnancy desires also call for attention, as Heather
Sipsma and colleagues show in a study of young couples expecting a
baby (page 244). Half of participants in this clinic-based sample had
wanted a pregnancy, and one in fi ve had been unsure. Characteristics
positively associated with pregnancy desire included perceptions of
partners’ wishes and both life and relationship satisfaction. Males were
more likely than females to have wanted a pregnancy and were less
accurate in their perception of their partners’ desires. The researchers
observe that on the assumption that teenage pregnancies are unwanted,
prevention efforts often focus on increasing knowledge and
improving contraceptive use. In their view, however, young people’s
pregnancy desires need further exploration “and may be an appropriate
focus of interventions.”

•In a mixed-methods study of homeless 13–24-year-olds in Los Angeles
(page 252), Joan S. Tucker and coauthors uncover a “disconnect”
between pregnancy-related attitudes and behaviors: Most youth considered
it very important to avoid pregnancy, but substantial proportions—
even among those highly motivated to do so—were not using
effective contraceptives. Findings from qualitative interviews and a
quantitative survey suggest that a number of social issues “may be
important to consider” in adapting or developing pregnancy prevention
programs for homeless young people: their strong feelings of
relationship commitment; their degree of ambivalence about pregnancy;
and their links to prosocial peers, such as youth who regularly
attend school.

•A study of family planning service providers in California, reported by
Heike Thiel de Bocanegra and colleagues (page 262), suggests that Title
X support may enable clinics to reduce barriers to care. Title X–funded
clinics responding to a 2010 survey were more likely than other public
facilities and private ones to offer extended clinic hours, provide outreach
to hard-to-reach populations and use technologies that can help
streamline clinic operations. “The California experience,” the authors
write, “suggests that if health reform provides clinical services for family
planning nationwide, Title X funding could provide an opportunity to
improve infrastructure and ensure quality of safety net providers, so
that they could potentially serve as the providers of choice.”